<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label for="c-card_front" class="control-label col-xs-12 col-sm-2">{:__('Card_front')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-card_front" data-rule="" class="form-control" size="50" name="row[card_front]" type="text" value="{$row.card_front}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-card_front" class="btn btn-danger faupload" data-input-id="c-card_front" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-card_front"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-card_front" class="btn btn-primary fachoose" data-input-id="c-card_front" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-card_front"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-card_front"></ul>
        </div>
    </div>
    <div class="form-group">
        <label for="c-card_back" class="control-label col-xs-12 col-sm-2">{:__('Card_back')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-card_back" data-rule="" class="form-control" size="50" name="row[card_back]" type="text" value="{$row.card_back}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-card_back" class="btn btn-danger faupload" data-input-id="c-card_back" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-card_back"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-card_back" class="btn btn-primary fachoose" data-input-id="c-card_back" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-card_back"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-card_back"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Real_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-real_name" class="form-control" name="row[real_name]" type="text" value="{$row.real_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Card_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-card_no" class="form-control" name="row[card_no]" type="text" value="{$row.card_no|htmlentities}">
        </div>
    </div>
    <!--<div class="form-group">
        <label for="c-bank_card_front" class="control-label col-xs-12 col-sm-2">{:__('Bank_card_front')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-bank_card_front" data-rule="" class="form-control" size="50" name="row[bank_card_front]" type="text" value="{$row.bank_card_front}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-bank_card_front" class="btn btn-danger faupload" data-input-id="c-bank_card_front" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-bank_card_front"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-bank_card_front" class="btn btn-primary fachoose" data-input-id="c-bank_card_front" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-bank_card_front"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-bank_card_front"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bank_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bank_name" class="form-control" name="row[bank_name]" type="text" value="{$row.bank_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bank_card_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bank_card_no" class="form-control" name="row[bank_card_no]" type="text" value="{$row.bank_card_no|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bank_city')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-bank_city" class="form-control" name="row[bank_city]" type="text" value="{$row.bank_city|htmlentities}"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bank_branch')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bank_branch" class="form-control" name="row[bank_branch]" type="text" value="{$row.bank_branch|htmlentities}">
        </div>
    </div>-->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="$row.status"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Reason')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-reason" class="form-control" name="row[reason]" type="text" value="{$row.reason|htmlentities}">
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
